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Table 1 Characteristics of included studies

From: Factors influencing contraceptive use or non-use among Aboriginal and Torres Strait Islander people: a systematic review and narrative synthesis

First Author Aim Design Location Participants Key Findings & Limitations
Bryant 2011 [27] Explore condom use in the context of sexual risk behaviour and STI transmission Quant (survey) NSW (34% from regional, remote or rural areas) 293 Aboriginal men and women, aged 16–30 years • Majority of participants were sexually active but condom use was inconsistent, intermittent or non-existent
• Potential bias due to non-probability sampling, public recruitment and self-reported data
Cox 1972 [28] Explore contraceptive practices, and acceptability of contraception Qual (NRa) SA (one remote community) 108 Pitjantjatjara women • Overview of contraceptive practices and attitudes in community, and recommendations for culturally appropriate care
• Study methodology and participant demographics not reported
Gray 1987 [29] Explore the family planning practices among women, in the context of (reported) fertility decline among Aboriginal people in the 1970’s Qual (NR) NSW, SA, WA, QLD (five communities) 251 Aboriginal women, aged 15–50 years • Most women were aware of the contraceptive methods available to them
• Over half of the women approved of contraceptive use in some circumstances, such as to space apart children
• Clear differences of opinion seen between five distinct communities
• Substantial number of women claimed no opinion in relation to one of the specific or general uses of family planning, highlighting sensitivity of the topic area
• Little information regarding the methodology employed and participant demographics not adequately reported
Griffiths 2016 [5] Assess the use, effectiveness and acceptance of prescribed contraception in three communities (focus on LARC) Mixed (Retrospective file review, semi-structured interviews) WA (three remote communities) Health records of 191 Aboriginal women, aged 12–50 years
20 additional women were interviewed
• High rates of LARC uptake, continuation rates comparable to those reported elsewhere, suggesting the acceptability of these methods.
• Contraceptive use potentially under-reported in these communities
• Women not using contraception were not represented
Helmer 2015 [23] Examine sexual behaviour and decision making in the context of everyday life experience and aspirations of Indigenous and non-Indigenous Australians Qual (Group discussions, body mapping, interviews) NT, WA, SA (urban and rural sites) 171 total participants, 88 of which identified as Indigenous, aged 16–25 years • Sex education provided in schools did not meet the needs of young people studied
• Findings limited to the context of sex education
• Condoms were the only form of contraception discussed in the paper
Ireland 2015 [30] Explore and describe young women’s behaviour and knowledge in relation to sexual health Qual (Ethnography) NT (one remote community) 12 Aboriginal women aged 16–33 and 19 Aboriginal women aged 40–90 • Lack of sexual health knowledge and risky sexual behaviours reported
• Women dissatisfied with the physical consequences of their contraceptive method were unaware of alternative choices
• Lack of generalisability to the broader population (little participant demographic information reported)
James 2018 [31] Examine the factors influencing postpartum contraception Qual (semi-structured interviews, focus groups) QLD
(one urban Community-Controlled Health Organisation)
17 Aboriginal women aged ≥16 years, who were less than 12 months post-partum • Most participants reported a desire for postpartum contraception, but reported barriers to accessing and using their preferred methods
• Sample did not include Torres Strait Islander women and had limited representation of women from remote areas
Johnston 2015 [26] Describe the views of sexual health service providers on access issues for young people and consider them with the views of young people themselves Mixed (semi-structured interviews, survey) QLD (four towns, regional and rural) 32 service providers (2 Aboriginal health workers) and 391 young people aged 15–24 years (11.3% Aboriginal and/or Torres Strait Islander) • Attitudes of service providers and their relationship with youth are more significant to young people than currently perceived by service providers themselves
• Only briefly reported on factors influencing contraceptive use for Aboriginal and Torres Strait Islander youth. Sampling strategy purposive, may be some selection bias
Larkins 2007, 2011 [17, 18] To explore the attitudes to pregnancy and parenthood among a group of Indigenous young people
To gain an understanding of the attitudes and behaviours of Indigenous young people regarding relationships, contraception and safe sex
Mixed (Survey, focus groups) QLD (Townsville) 186 Indigenous people aged 12–18 years, and 10 Indigenous women with children or pregnant • Many held idealised notions of parenthood
• Motherhood was considered transformative, and an opportunity to make positive lifestyle changes for the sake of the baby
• Small number of interview participants (N = 10) limits generalisability, limited reporting of survey (N = 186) and focus group results (N = 59)
• Nearly half of participants were sexually active
• In survey responses, 60% of participants reported condom use, and 26% reported hormonal contraceptive use
• Barriers to use were reported
• Self-reported data, sample not representative or generalisable
Mooney-Somers 2012 [24] Examine how young Indigenous Australians keep themselves healthy and protected against STIs Qual (Interviews) QLD (Townsville) 45 men and women aged 17–26 years who self-identified as Aboriginal and Torres Strait Islander, at risk of or experiencing homelessness • Health behaviours are complex, and not static over time
• Condom use contingent on sexual partner, relationship, context and access
• Focus of the paper is homelessness, and findings should be interpreted within this context
Reid 1979a, 1979b [19, 20] Review the attitudes of Aboriginal women towards family size, spacing and planning, and explore attitudes towards childbearing and family planning Qual (Interviews) Northern Australian community 92 Aboriginal women, aged ≥15 years • Lack of culturally appropriate services in community
• Many participants had positive attitudes towards contraception, and reported preferences for family size and spacing
• Little methodological information provided
Roberts 1997 [32] Investigate the attitudes of Aboriginal women towards the use of condoms to prevent HIV and other STIs Qual
(Interviews)
NT (Darwin) 12 Aboriginal women, aged 19–44 • Although participants were aware of condoms and their protection against STI’s, few used them, and they were generally considered unfavourably
• Small study of limited generalisability. All participants were students in university preparation courses
Samisoni 1980a, 1980b [21, 22] Explore family planning and contraceptive practices among Aboriginal women Qual (Semi-structured interviews) QLD (Brisbane) 236 Aboriginal women • Oral contraceptives were the most popular method used, although many reported unintended pregnancies in the context of contraceptive use
• Experiences of side effects impacted continuation rates
• Little methodological information provided and participant demographic information lacking
Scott 2015 [25] Explore sexual risk and healthcare seeking behaviour among Aboriginal and Torres Strait Islander youth Quant (Survey) QLD (Townsville) 155 Aboriginal and Torres Strait Islander people, aged 16–24 years • Three quarters of participants reported carrying condoms at least sometimes, and 82% had used a condom in their last casual sexual encounter
• Men were more likely to report condom use than women.
• Non-random selection of sample not generalisable to broader population
• Peer interviewers known to participants, which may have impacted responses to the interviewer-administered survey
• Data self-reported, which may be subject to recall bias
Stark 2007 [33] Examine current levels of knowledge regarding STIs and their transmission, perception of risk of STIs, patterns of, access to and experiences with negotiating condom use Qual (Interview) NT (one remote community) 24 Aboriginal women, aged 18–35 years • Poor knowledge of STI transmission, limited condom access and limited condom use was reported
• Sexual activity in the context of alcohol use, reduced ability and/or desire to negotiate condom use
• Small sample limits generalisability.
• Participant responses may have been impacted by relationship with the researcher (a non-Aboriginal woman and nurse in the community), cultural and linguistic misunderstandings in questions and answers, and sensitive nature of the face-to-face interviews
Williams 2015 [34] Describe the sexual health behaviour, alcohol and other drug use and health service use among young people Quant (Survey) WA (Perth, and south-west WA) 244 Aboriginal men and women, aged 16–30 years • Participants initiated sexual activity at a young age
• Men reported carrying condoms more often than women, and men also reported use at last casual sex more often than women
• Data should be interpreted cautiously, as there were high non-response rates to questions about sexual behaviours
Willis 2003 [35] Report on the culture-specific barriers that masculinity poses to preventing HIV transmission among Pitjantjatjara men. Qual (Ethnography) NT (remote communities) Pitjantjatjara and Yankunytjatjara men • Significant cultural barriers to condom use were reported
• Little methodological information provided, and participant demographics lacking
  1. aNR not reported